Which cells to choose?

Bone marrow transplant patients gather on the Fred Hutch campus for the 2015 BMT reunion. Fred Hutch researchers played a pivotal role in developing bone marrow transplantation, a procedure that has been conducted more than 1 million times worldwide and saved hundreds of thousands of lives.

Photo by Robert Hood / Fred Hutch News Service

For many patients with blood diseases like leukemia, their best shot at survival is to replace their diseased blood and immune cells with a transplant of healthy cells from an unrelated donor. A new study published this month provides those in need of these lifesaving transplants with additional information to guide a critical choice ― deciding whether cells for transplant be collected from the donor’s bloodstream or taken from their bone marrow.

A large, nationwide study published this month in the journal JAMA Oncology found that people who received transplants of cells collected from the donor’s bone marrow ― the original source for blood stem cell transplants, developed decades ago ― had better self-reported psychological well-being, experienced fewer symptoms of a common post-transplant side effect and were more likely to be back at work five years after transplant than those whose transplanted cells were taken from the donor’s bloodstream.

“We're hoping that once we provide information about long-term quality of life and recovery, patients and their doctors can take this into account when they're planning their transplants,” said lead author Dr. Stephanie Lee, a physician-scientist with Fred Hutchinson Cancer Research Center. She noted that the results would only be applicable to transplant patients who are similar to those enrolled in the trial.

The study also showed that there was no difference in overall survival, treatment-related death or relapse between the two groups of study participants. Lee said that this result would reassure the many patients for whom survival is the top concern.

“If [survival] is similar, then some of these other considerations, like how you feel and how you recover, may factor more strongly into people’s treatment decisions,” she said.

The study included 551 people between age 16 and 66 with leukemia or certain other blood malignancies who needed to receive a transplant of blood-forming stem cells from an unrelated donor. The patients were randomly assigned to one of the two types of transplants. From six months to five years after the transplant, study researchers called the participants periodically to assess how they were doing.

The researchers found that people whose transplanted cells were derived from their donor’s bone marrow were more likely to report better psychological well-being than those assigned to receive the stem cells from circulating blood. They were also much more likely to have returned to at least part-time work than their counterparts in the other transplant group.

The researchers suspected, but could not confirm, that these patients had better emotional well-being because they also experienced fewer self-reported symptoms of chronic graft-vs.-host disease and had fewer side effects from GVHD treatment. Chronic GVHD is a common transplant complication in which transplanted immune cells turn against the patient’s healthy cells, causing symptoms such as a debilitating thickening of the skin and permanent loss of lung function.

Lee’s recent study is the latest example of the decades of research by many scientists that has continued to improve bone marrow transplantation and related forms of blood stem cell transplantation by boosting the therapy’s success rates and decreasing toxicity.

“When both your disease and the recommended treatment are life-threatening, I don’t think people are necessarily asking ‘Which treatment is going to give me better quality of life years from now?’,” Lee said. “Yet, if you’re going to make it through, as many patients do, you want to do it with good quality of life. That’s the whole point of having the transplant. It’s not just to cure your disease but to try to get back to as normal of lifestyle as you can.”

Susan Keown is a staff writer at Fred Hutchinson Cancer Research Center. Before joining Fred Hutch in 2014, Susan wrote about health and research topics for a variety of research institutions, including the National Institutes of Health and the Centers for Disease Control and Prevention. Reach her at skeown@fhcrc.org.

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